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General NPI Number Information
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NPI Number | 1215685896
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Entity Type | Organization
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Legal Business Name | POTOMAC DERMATOLOGY AND SKINCARE CENTER
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 9812 FALLS RD STE 124
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City | POTOMAC
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State | MD
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Zip | 20854-3976
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Country | US
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Telephone | 703-356-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 6849 OLD DOMINION DR STE 450
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City | MC LEAN
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State | VA
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Zip | 22101-3718
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Country | US
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Telephone | 703-626-3648
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LILY TALAKOUB
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Credential | MD
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Telephone | 703-626-3648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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